Spine deformity最新文献

Introduction: Pediatric spine surgery has traditionally been a subspecialty within pediatric orthopedics. This study aimed to analyze changes over time in the proportion of pediatric spinal deformity cases performed by orthopedic surgery and neurosurgery, and to identify trends in the practice patterns and peri-operative variables of these specialties.

Methods: This was a retrospective cohort study using the National Surgical Quality Improvement Program Pediatric database (NSQIP) years 2016-2022. Inclusion criteria are patients < 18 years of age undergoing posterior spinal instrumented fusion for spinal deformity. Outcomes included: specialty of surgeon (orthopedic surgery, pediatric orthopedic surgery, neurosurgery, pediatric neurosurgery), patient age (< 10 years vs. 10-18 years), perioperative allogeneic transfusion, 30-day reoperation, deep surgical site infection, operative time, and length of stay. Descriptive statistics, Chi-square test, and Students' t test were used for analysis.

Results: There were 37,443 patients meeting inclusion criteria. Orthopedic surgery, pediatric orthopedic surgery, neurosurgery, and pediatric neurosurgery performed 8.0%, 90.4%, 0.2%, and 1.3% of the cases, respectively. From 2016 to 2022, there was an increase in the proportion of cases performed by pediatric neurosurgery from 0.7 to 1.2% and a decrease in the proportion of cases performed by pediatric orthopedic surgery from 93.2 to 87.6%. Pediatric neurosurgery performed the highest proportion of cases in patients < 10 years of age (10.8%, p < 0.001). Pediatric orthopedic surgery performed the lowest proportion of cases in patients that have had previous spinal deformity surgery (4.4%, p  < 0.001). Orthopedic surgery had the highest proportion of idiopathic cases (72.7%), whereas pediatric neurosurgery had the lowest (47.0%). For idiopathic scoliosis, neurosurgery and pediatric neurosurgery had higher rates of allogeneic transfusion (p  < 0.001) and longer lengths of stay (p  < 0.001). There were no differences in rates of 30-day reoperation or deep surgical site infection.

Conclusion: In the NSQIP database, the great majority of posterior spine fusions with instrumentation continue to be performed by pediatric orthopedic surgeons. Differences exist among these specialties in terms of patient demographics and perioperative surgical variables.

Introduction: Adult spinal deformity (ASD) often necessitates high-grade osteotomies to achieve adequate correction and durable arthrodesis, yet guidance on adjunctive interbody cage use remains fragmented. This systematic review aims to aggregate and critically appraise clinical and radiographic outcomes of interbody cage use in Schwab grade 3 and 4 osteotomies to provide evidence-based guidance for complex ASD correction.

Methods: We conducted a PROSPERO-registered systematic review and meta-analysis (CRD420251068532) of comparative studies to evaluate perioperative characteristics of ASD patients undergoing corrective high-grade osteotomies. We queried PubMed, EMBASE, and CINAHL databases through June 7th, 2025. Inclusion criteria were studies that examined ASD patients who underwent high-grade osteotomy and reported postoperative metrics such as blood loss, final degree of correction, and complication rates. A random-effects binary and continuous model for meta-analysis was performed using risk ratios.

Results: Four comparative studies (n = 367; 50.41% male; mean age 57.75 ± 11.1 years) were included. Baseline mean preoperative sagittal vertical axis (SVA), Visual Analog Pain scores (VAS), and Oswestry Disability Index scores (ODI) for the total cohort were 19.40 cm ± 10.90 cm, 57.26 ± 25.13, and 61.91 ± 17.74, respectively. There was no significant difference in operative time regardless of cage use (mean time Cage: 461.76 ± 158.65 min; No Cage: 452.47 ± 169.04 min, mean difference (MD): 22.01; CI [- 13.92, 57.94] p = 0.23). There was no significant difference in intraoperative blood loss regardless of cage use (mean Cage: 1,576.29 ml ± 483.58 ml; No Cage: 1,513.64 ml ± 844.41 ml; MD: 49.53; CI [- 127.65, 226.72], p = 0.584). Osteotomies with cage use had a significantly lower postoperative SVA compared to cageless osteotomies (mean Cage SVA: 5.20 ± 2.55 cm; No Cage: 5.81 ± 2.50 cm; p = 0.03). There was no significant difference in ODI regardless of cage use (mean ODI Cage: 29.04 ± 5.84; No Cage: 35.42 ± 5.46 cm; p = 0.116). When comparing outcomes between patients with or without cages, no differences were seen in instances of rod fractures (6.94% vs 4.64%), proximal junctional kyphosis (15.61% vs 14.9%), or proximal junctional failure (4.05% vs 4.12%) respectively (p > 0.05).

Conclusion: ASD patients who underwent high-grade osteotomies with an interbody cage had lower postoperative SVA compared to patients who underwent cageless osteotomies. No differences were seen in operative time, blood loss, complication rates, or patient-reported outcomes between groups. Cage use may benefit patients at higher risk for nonunion or mechanical failure. Further prospective studies are needed to better define the role of cages in ASD correction.

Purpose: This study aimed to investigate differences in muscle synergies during gait between individuals with adult spinal deformity (ASD) and healthy controls and to assess whether fear of falling influences this. Muscle synergies represent modular neural strategies by which the central nervous system simplifies motor control through combinations of basic muscle activation patterns. A reduction in synergies may indicate decreased neuromuscular adaptability and has been linked with impaired gait.

Methods: 59 individuals with ASD and 17 age- and sex-matched controls were recruited. Surface electromyography of four bilateral trunk and three bilateral lower-limb muscles was recorded. Muscle synergies were extracted via non-negative matrix factorization at a threshold of 95% variance accounted for. Fear of falling was evaluated using the Falls Efficacy Scale-International. Participants were stratified into deformity subgroups using radiographic criteria (decompensated sagittal, compensated sagittal, and coronal malalignment). Ordinal logistic regression assessed the fear of falling, BMI, pain, and subgroups in relation to synergy count.

Results: ASD participants exhibited fewer synergies (χ² = 14.08, p < 0.001) compared to controls. Regression analysis revealed that BMI and deformity subgroups were significantly associated with synergy count, while fear of falling was not, potentially due to its correlation with BMI. Participants with decompensated sagittal alignment had significantly fewer synergies than both those with coronal malalignment and healthy controls. ASD participants had higher FES-I scores than controls (p < 0.001).

Conclusions: Individuals with ASD demonstrate a simplified neuromuscular control during gait. The deformity subgroups and BMI were associated with synergy count. The elevated fear of falling underscores the need for targeted fall-related interventions in this population.

Purpose: Non-depolarizing neuromuscular blocking agents (nNMBAs) have been subjectively reported to make spinal exposure more efficient. However, there is concern that neuromonitoring may be compromised, even with reversal, and may mask neuromonitoring alerts or result in an increased risk of postoperative neurological complications. We sought to describe the safety of using nNMBAs to facilitate exposure in pediatric posterior spine fusion surgery (PSF).

Methods: All consecutive adolescent idiopathic scoliosis (AIS) patients who underwent PSF at a single institution between 2014 and 2022 were included. Baseline patient comorbidities, utilization of nNMBAs and reversal agents, neuromonitoring changes, surgical details, postoperative neurological deficits, and surgical complications were recorded. Patients were grouped based on nNMBA utilization (-nNMBA or +nNMBA) and their outcomes were compared using univariable and multivariable techniques. Significance was set at α = 0.05.

Results: Three hundred twenty-seven patients met all selection criteria and were included. Of these, 49 (15%) did not receive any nNMBA (-nNMBA) and 278 (85%) did receive a nNMBA (+nNMBA). Baseline patient characteristics were not different between the two groups. There were no significant differences in the rate of intraoperative neuromonitoring changes (6.1% -nNMBA versus 8.6% +nNMBA, p = 0.78), postoperative neurological deficits (6.1% -nNMBA versus 5.8% +nNMBA, p = 0.25), or postoperative complications (22.4%, -nNMBA; 21.6%, +nNMBA; p = 0.85). Modified Clavien-Dindo-Sink complication grades were not different between groups (p = 0.81).

Conclusion: The study found no difference in the rate or severity of complications, rate of neuromonitoring alerts, or rate postoperative neurological changes between -nNMBA and +nNMBA groups.

Level of evidence: Level III, therapeutic.

Introduction: There is a paucity of data on the use, efficacy, and safety of antifibrinolytic agents (AF) in patients with neuromuscular scoliosis undergoing growth-friendly instrumentation. Previous studies have shown mixed results of AF agents in young patients with neuromuscular conditions, and other authors have expressed concerns regarding adverse effects in this medically fragile population. The purpose of this study was to investigate the rate of use of AF agents for growth-friendly surgery in patients with neuromuscular scoliosis, and assess its impact on blood loss and transfusion requirements.

Methods: This is a retrospective cohort study of patients from a multicenter spine study group with neuromuscular scoliosis that underwent an index growth-friendly procedure. Patients with a history of venous thromboembolism and those undergoing revision surgery or lengthening surgery were excluded. Perioperative data were collected including patient demographics, type of instrumentation, use and type of AF agent, estimated blood loss (EBL), use and volume of cell saver, and intraoperative blood transfusion. Univariate statistics were used to determine differences.

Results: This study included 335 patients with a mean age of 7 years (SD: 2.6). Of these patients, 176 patients were managed with VEPTR/TGR instrumentation and 159 patients were managed with MCGR instrumentation. AF agents were used in 36% of index cases. In cases with AF use, TXA was the most frequently used agent (TXA:68%, ACA:21%). The use of AF increased over the study period from less than 10% before 2010 to 75% in 2020 (R² = 0.31). There was no statistical difference in EBL between patients who received AF agents compared to patients that did not receive AF agents (AF = 184.9 ml, no AF = 103 ml, p = 0.23). In addition, there was no difference in cell saver volume (AF = 127 ml, no AF = 145 ml, p = 0.88). The overall rate of intraoperative blood transfusion was low (8.5%). In this cohort, there was no significant difference in transfusion rates between groups (AF = 7.6%, no AF = 8.7%, p = 0.7). There was a high rate of postoperative blood transfusion (51.4%) in this cohort; however, there was no significant difference in postoperative transfusion rates between groups (AF = 62.1%, no AF = 50.5%, p = 0.62).

Conclusion: AF agents are being used for patients undergoing growth-friendly procedures with TXA being the most commonly used AF. However, there is no significant difference in EBL, cell saver volume, and intraoperative or postoperative transfusion rates between patients that do or do not receive AF agents for these procedures. Additional studies are needed to validate these results, as well as determine their efficacy, safety, and value in this medically fragile group.

Introduction: Few studies directly compare the efficacy of magnetic-controlled and traditional growing rods for early onset scoliosis (EOS) treatment from pre-implantation to definitive fusion or final lengthening. We hypothesize that TGR is more efficient than MCGR in achieving more spine length and curve correction but at the cost of more complications. We also hypothesize that patient-reported outcomes and pulmonary function are minimally changed after completion of treatment.

Methods: All patients treated at one institution between 2010 and 2022 who graduated from growth-sparing treatment and had undergone definitive fusion or were being observed with retained implants were evaluated. T1-T12 and T1-S1 lengths and curve magnitude were recorded at 3 time points on coronal films: pre-op, prior to definitive fusion or after final lengthening, and post-definitive fusion or last observation. EOSQ-24 scores, PFTs, and complications were collected.

Results: Fifty-one patients (27 MCGR, 24 TGR) had complete graduation radiographs. Age of insertion was no different (MCGR- age 7 vs. TGR-6.5, p = 0.14) or at removal (MCGR-11.7 vs TGR-11.3, p = 0.48). MCGR patients had smaller initial curves (81 vs 89° p = .02), which remained smaller (32° vs TGR 50°, p < .001) after definitive fusion. T1-12 length was initially shorter for TGR (14.8 vs 16.3 cm, p = .05) but no different at pre-definitive due to more effective TGR length gain (TGR > MCGR 5.8 vs 3.6 cm p = .006). Similarly, TGR gained more T1-S1 length than MCGR (8.9 vs 6.1 cm, p = .01). Overall TGR patients gained greater length but at the cost of more complications per patient than MCGR (2.4 vs 1.5 p = 0.0035) and more UPRORs (p = .04). TGR patients gained greater absolute and % predicted PFT volumes compared to preoperative values which did not occur in the MCGR cohort. EOSQ-24 scores for MCGR improved in several domains.

Conclusion: Deformity correction was primarily achieved at initial implantation surgery for both techniques, though MCGR patients achieved even smaller curves after definitive fusion compared to TGR. TGR lengthened more effectively than MCGR but with more complications and UPRORs. PFTs were improved for TGR patients but not for MCGR, while EOSQ scores in the MCGR cohort were modestly improved.

Purpose: This study investigates blood pressure variations and clinical outcomes in paediatric neuromuscular scoliosis patients after deformity correction surgery to mitigate the risk of ischaemic spinal cord injury (SCI). Hypotension is proposed as an aetiological mechanism for delayed SCI, but there is limited evidence regarding the frequency, severity, duration, and clinical effect of hypotension exposure in the immediate post-operative period.

Methods: This is a retrospective review of 94 patients with cerebral palsy or CP-like conditions, who underwent posterior spinal instrumentation at Queensland Children's Hospital. Post-operative mean arterial pressure (MAP) variations and associations with tissue perfusion markers were analysed. Hypotension was described using area under threshold (AUT) and time under threshold (TUT) for MAP thresholds of 40-80 mmHg.

Results: 14.9% of patients experienced an episode of hypotension under 60 mmHg lasting ≥ 60 min, compared to 62.4% at 70 mmHg. At the 60 mmHg threshold, mean TUT was 9.2%, 95% CI [6.55, 11.8], compared to 40.9%, 95% CI [35.1, 46.6] at 70 mmHg. Logistic regression revealed increased hypotension exposure under thresholds of 60 and 65 mmHg over a 60-min period was associated with increased risk of hyperlactataemia (AUT, 60 mmHg threshold β = 2.85, OR 17, p = 0.03, 95% CI [0.22-5.48]. Increased AUT exposure was associated with low urine output at thresholds ≥ 60 mmHg over 30 min. Haemoglobin ≤ 80 g/L was associated with elevated lactate.

Conclusion: Periods of sustained hypotension were common and usually without neurologic sequalae; however, a MAP below 60 and 65 mmHg sustained for 60 min was associated with surrogate markers of global tissue hypoperfusion.

Purpose: The United States (US) adult population's baseline knowledge and perceptions of adult spinal deformity (ASD) are unknown. This study employs crowdsourcing to evaluate public perceptions regarding ASD.

Methods: This is a survey-based study comprising a representative sample. A multiple-choice survey was administered through the CloudResearch platform and participants were matched for age, sex, and other demographics to reflect the current US census.

Results: 1000 participants were included with a mean age of 45.3 ± 16.1 years. Respondents ≥ 65 years old were significantly more likely to never have been screened for scoliosis compared to the 18-64 cohort (62% vs. 38%; p < 0.05). The majority of respondents (54%) correctly responded that X-ray is the typical diagnostic tool. Primary treatment modalities thought most useful by participants were physical therapy (80%) followed by spinal braces (66%). In terms of surgical treatment, 61% stated that fusion surgery was the typical treatment whereas 51% felt that motion-preserving surgery with disc replacement was a viable treatment option. Participants were most likely to identify orthopedic surgeons (81%) as most likely to treat ASD, followed by physical therapists (75%). The majority (80%) believed that surgery was effective treatment and only 4% believed that surgery was ineffective. Respondents ≥ 65 years old were significantly more likely to rely on primary-care referral (95% vs. 89%; p < 0.05) for selecting a surgeon and less likely to rely on health insurance, hospital name, and social media. The majority of respondents (73%) expected to return to baseline after surgery with only some minor limitations. Only 2% of respondents thought that the rate of any complication or likelihood of reoperation was ≥ 50%.

Conclusion: This study is the first of its kind to utilize an online crowd-sourced survey to comprehensively investigate perceptions of ASD and demonstrates a trend toward significantly lower scoliosis screening rates in respondents > 65 years old. While awareness was relatively high in domains, such as symptoms, diagnosis, and treatment, common misconceptions persisted regarding disease pathophysiology, expected recovery, complications, and pain; areas where perceptions underestimated risks compared with published outcomes. These findings highlight important knowledge gaps that may influence care-seeking behavior, referral patterns, and expectation management, demonstrating the need for targeted educational initiatives.

Purpose: Various risk factors for curve progression during brace treatment in adolescents with idiopathic scoliosis (AIS) have been identified. However, curve-type-specific risk factors remain unclear. We aimed to identify risk factors for curve progression by curve type.

Methods: At our hospital, we analyzed 211 patients with AIS (200 females, 11 males). X-rays were obtained before and immediately after brace application. Patients were categorized into those requiring surgery during follow-up (Surgery group) and those avoiding surgery (Avoidance group). Univariate and multivariate analyses identified risk factors for curve progression. Subgroup analysis was performed based on curve type.

Results: Among all cases, 163 (77.3%) avoided surgery. In the univariate analysis, the Surgery group was significantly younger (p = 0.008), had a lower BMI (p < 0.001), a lower TOCI grade (p < 0.001), a lower Risser classification (p < 0.001), included more premenarcheal individuals (p < 0.001), had larger pre- and post-brace Cobb angles (p < 0.001), and fewer thoracolumbar/lumbar curves (p = 0.002) than the Avoidance group. Multivariate analysis showed that a lower TOCI grade (p = 0.005), thoracic curve type (p < 0.001), a larger post-brace Cobb angle (p = 0.001), and greater post-brace apical vertebral translation (AVT) (p = 0.006) were significant risk factors for requiring surgery. In both thoracic (N = 101) and thoracolumbar/lumbar curves (N = 110), the Surgery group had significantly larger pre- and post-brace Cobb angles (p < 0.001/p < 0.001 and p = 0.005/p < 0.001, respectively), and larger pre- and post-brace AVT (p = 0.049/p = 0.004 and p < 0.001/p < 0.001) than the Avoidance group.

Conclusion: In both thoracic and thoracolumbar/lumbar curves, reduction in the Cobb angle and AVT at the time of brace application is crucial for successful AIS management.

Background: Scheuermann kyphosis (SK) is a spinal deformity characterized by exaggerated kyphosis, frequently requiring surgical correction. Selection of the lowest instrumented vertebra (LIV) is critical in optimizing outcomes, with options including the stable sagittal vertebra (SSV) and first lordotic vertebra (FLV). This systematic review evaluates the clinico-radiological outcomes and complications associated with SSV and FLV as LIVs.

Methods: A systematic review were conducted following PRISMA guidelines. Seven studies comprising 311 patients (142 in the SSV group and 169 in the FLV group) were included. Outcomes analyzed included pre- and postoperative radiographic parameters (kyphosis, lumbar lordosis, sagittal balance), correction rates, incidence of distal junctional kyphosis (DJK), and revision surgery for DJK. Statistical analysis used Review Manager 5.4 with heterogeneity assessed using I² and Q tests. Evidence quality was evaluated using the GRADE framework.

Results: Pre- and postoperative kyphosis was significantly higher in the SSV group, while lumbar lordosis and sagittal balance were comparable. Although the correction rates were similar between groups, the incidence of DJK was significantly higher in the FLV group (OR 0.20, p = 0.04). Sensitivity analysis revealed that after removing the most heterogeneous study, the difference in DJK incidence was no longer statistically significant. Revision surgeries for DJK remained significantly higher in the FLV group (OR 0.26, p = 0.01).

Conclusion: Fusion to SSV may reduce the incidence of DJK and revision surgery compared to FLV, with comparable radiological outcomes. However, these findings were sensitive to study heterogeneity, and the significance of DJK difference disappeared after sensitivity analysis, highlighting the need for further prospective studies with larger sample sizes to strengthen the evidence.